Home Health Aides – More Than Just Babysitters

The subject of raising the minimum wage has been a theme in the news for the last several weeks. You might be surprised to learn that many home health aides will see no benefit from any possible bump to the current $7.25 an hour rate – I know I was, when I read an article from CNN Money posted on one of my new favorite blogs, The Voice of Aging Boomers. It turns out that many home health aides are grouped with babysitters in U.S. labor laws, and so those who hire them are exempt from paying them anything more than what you give that nice high school girl to watch your 12-year-old when you go out to dinner for the evening.

The category these two very different occupations share is called “companionship worker,” and by their presence in it, home health aides are assumed to spend at least 80% of their workweek simply keeping a patient company. One quote in the article took my breath away: “What they do is static, there’s not a lot of effort.” This was from Val Halamandaris, president of the National Association for Home Care & Hospice. As you might expect, this group represents the owners of home health agencies, not their employees. In fact, the organization doesn’t believe that the workers should even get an overtime bonus.

Home health aides were critical in helping me keep my father living with me for the 3-1/2 years he lived under my roof. After his first hospitalization and rehab stay, we received a benefit from Dad’s Medicare Advantage plan of an aide twice a week to help Dad in and out of the shower. That benefit only lasted three weeks or so, but he never quite recovered his balance. So I talked Dad into paying for two one-hour visits a week to continue the service. (OK, “talk” probably doesn’t quite describe the forcefulness of those conversations, but he did finally agree.) We turned to the same visiting nurse group that had done the job through his insurance company, so we could have the same aides with whom Dad was already comfortable.

This wasn’t a simple companionship service, it was real work. In addition to helping Dad with his shower, the aides also would change the bed (and mattress protectors) and sometimes even do the morning dishes. It helped me spend more time working and it gave Dad some more people to interact with during the day. I think the aides might have gotten $20 from the $30 to $35 hourly rate we paid the agency, and they earned every penny. Once Dad lost his license and couldn’t drive anymore, we hired another aide who was more of a companion (and who became a very good friend to Dad) to take him out for errands and lunch a couple times a week – this was a bargain at $18 an hour (which included her mileage).

We were very lucky that Dad could afford this expense – which is, of course, at the heart of the whole conversation regarding home aides and their compensation. Older folks needing extra help to stay in their homes are often on fixed incomes, and what could be a fairer wage might be out of their limited budgets. Medicare only covers limited home health assistance. Medicaid is beginning to cover some of these services in some states, but only after the person has spent down their assets to near-poverty levels and only if they meet criteria for need in specified activities of daily living. (The irony of this last requirement, of course, is that home assistance could prevent accidents that might end up resulting in even more severe health complications.) On the other side, though, the low wages forced on many caregivers by the market means many of those workers require government assistance simply to keep food on their own families’ tables.

I don’t have any solutions to offer, beyond the assertion that any solution has to involve workers earning a living wage.